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General NPI Number Information
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NPI Number | 1154915114
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Entity Type | Individual
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Provider Name | JOSEPH CLIFFORD STEVENS CPHT
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Gender | Male
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Dates
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Enumeration Date | 02/21/2021
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Last Update Date | 02/21/2021
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Provider Practice Location Address
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Address Line | 8145 SE 17TH AVE
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City | PORTLAND
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State | OR
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Zip | 97202-6718
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Country | US
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Telephone | 503-382-2253
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Fax | 971-407-4795
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Provider Business Mailing Address
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Address Line | 1701 SW COLUMBIA ST APT 308
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City | PORTLAND
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State | OR
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Zip | 97201-2589
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Country | US
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Telephone | 503-507-8431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | CPT-0012757
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License Number State | OR
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